目的：使用扫频源光学相干断层扫描（SS-OCT），根据视网膜色素上皮（RPE）泵对视网膜下间隙的调节程度，描述RRD患者的不同形态特征。
方法：前瞻性临床队列研究。方法设置：圣迈克尔医院，多伦多,加拿大,从2020年8月至2023年8月。
方法：120眼连续进行原发性RRD。
■亚临床，非进步,局部RRD定义为调节与急性,进步,广泛定义为使用扫频源SS-OCT评估失调。
结果：用SS-OCT观察RRD调节与失调的形态学特征。
结果：19.2%(23/120)的RRD被分类为调节的，80.8%(97/120)的RRD被分类为失调的。RRD调节患者的平均年龄为37.1岁（±13.7SD），而RRD失调患者的平均年龄为62.6岁（±11.6SD）（P<0.001）。在OCT上观察到4.3%(1/23)的调节RRD和81.4%(79/97)的异常RRD存在外部视网膜波纹(ORC)(P<0.001)。在41.6％（5/12）的调节RRD中发现了CME，而在87.3％（83/95）的失调RRD中发现了CME（P<0.001）。当控制年龄时，ORC的存在是RRD失调的独立预测因子（P=0.02，β=6.6,95CI[1.3-33.2]），性别,基线VA,镜头状态,和RD范围。在RRD受管制的患者中，25.0%(3/12)处于阶段2，0%(0/16)处于阶段3A，在3B阶段为8.3%(1/12)，第4阶段为0%（0/16），第5阶段为66.7%（8/12）。在RRD失调的患者中，14.7%(14/95)处于阶段2，15.7%(15/95)处于阶段3A，阶段3B的37.9%（36/95），第4阶段为22.1%(21/95)，第5阶段为9.5%(9/95)(P<0.001)。
结论：使用SS-OCT在调节和失调的RRD之间存在显著的形态学差异。ORC存在于几乎所有失调的病例中,但存在于少数调节的病例中,并且它们是RPE-光感受器调节状态的独立预测因子。人口统计学和临床特征区分调节和失调的RRD，了解这些差异对于最佳管理和术后结局具有重要意义。
OBJECTIVE: To describe varying morphological features of patients with RRD based on the extent of regulation of the subretinal space by the retinal pigment epithelium (RPE) pump using swept-source optical coherence tomography (SS-OCT).
METHODS: Prospective clinical cohort study.
METHODS: Setting: St. Michael\'s Hospital, Toronto, Canada, from August 2020-August 2023.
METHODS: 120 consecutive eyes with primary RRD. Cohorts: Subclinical, non-progressive, localized RRD defined as regulated vs. acute, progressive, and extensive defined as dysregulated, assessed with SS-OCT.
RESULTS: Morphological features of regulated vs. dysregulated RRDs with SS-OCT.
RESULTS: 19.2% (23/120) of RRDs were classified as regulated and 80.8% (97/120) were dysregulated. The mean age of patients with regulated RRDs was 37.1 years (±13.7 SD) vs. 62.6 years (±11.6SD) for patients with dysregulated RRDs (P < .001). The presence of outer retinal corrugations (ORCs) on OCT was observed in 4.3% (1/23) of regulated vs. 81.4% (79/97) of dysregulated RRDs (P < .001). CME was found in 41.6% (5/12) of regulated RRDs compared to 87.3% (83/95) of dysregulated RRDs (P < .001). ORC presence was an independent predictor of having a dysregulated RRD (P = .02, β = 6.6, 95% CI [1.3-33.2]) when controlling for age, sex, baseline VA, lens status, and RD extent. Among patients with regulated RRDs, 25.0% (3/12) were in Stage 2, 0% (0/16) in Stage 3A, 8.3% (1/12) in Stage 3B, 0% (0/16) in Stage 4, and 66.7% (8/12) in Stage 5. In patients with dysregulated RRDs, 14.7% (14/95) were in Stage 2, 15.7% (15/95) were in Stage 3A, 37.9% (36/95) in Stage 3B, 22.1% (21/95) in Stage 4, and 9.5% (9/95) in Stage 5 (P < .001).
CONCLUSIONS: There are significant morphologic differences between regulated and dysregulated RRDs using SS-OCT. ORCs are present in almost all dysregulated cases but in a minority of regulated cases and they are an independent predictor of RPE-photoreceptor regulation status. Demographic and clinical features differentiate regulated and dysregulated RRD and understanding these differences has significant implications for optimal management and postoperative outcomes.
